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Gastrointestinal stromal tumour of Stomach

Gastrointestinal stromal tumour of Stomach. 50% occur in stomach, constitutes 1-3% of all gastric neoplasia Previously mistaken for leiomyoma or leiomyosarcoma They are arise of mesenchymal origin, from the interstitial (pacemaker) cells of Cajal .

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Gastrointestinal stromal tumour of Stomach

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  1. Gastrointestinal stromal tumourof Stomach

  2. 50% occur in stomach, constitutes 1-3% of all gastric neoplasia • Previously mistaken for leiomyoma or leiomyosarcoma • They are arise of mesenchymalorigin, from the interstitial (pacemaker) cells of Cajal. • Associated with mutation in the tyrosine kinase c-kit oncogene. • Equal incidence in males and females

  3. Biological behavior is unpredictable. Size >5cm and mitotic index are predictors of metastasis. • May spread to liver, peritoneum. Lymph nodal spread is rare

  4. May be small and asymptomatic. • May ulcerate and cause bleeding • Large tumors may present like gastric cancers • Endoscopic biopsy useful in only ulcerated tumours. • Endoscopic usg and targeted biopsy may be successful in getting a representative tissue for diagnosis. • CT scan-

  5. Surgical resection with tumour free margins is the best line of treatment. Wedge local excision, gastrectomy usually without lymphadenectomy. • Large tumours with extensive local spread/ metastasis are treated by imatinib which is a tyrosine kinase inhibitor, for 3-6 months pre-operatively. Liver metastasis can be resected. • Large, metastatic tumours will require life long imatinib therapy post- operatively. • Sunitinib for patients with imatinibresistenttumours

  6. Gastric Lymphomas • Primary or gastric involvement of a generalised lymphoma • Primary Gastric lymphoma forms about 5% of all gastric neoplasms • Common in 6th decade of life. May be due to H.pylori. • Clinical features- similar to carcinoma of stomach. Pain abdomen, weight loss, bleeding • B cell in origin, arise from the mucosa associated lymphoid tissue. They are confined to stomach and lymph node spread occurs after a long time

  7. Endoscopy- early stages- diffuse mucosal thickening, mucosal ulceration. Biopsy to confirm the diagnosis. • Investigations- CT scan of abdomen and chest, bone marrow study to find out if it is primary gastric lymphoma or a part of generalised lymphoma. Complete blood count. • Treatment- may respond to H. pylori eradication. Primary gastric lymphoma is best treated by gastrectomy. Can also be treated by chemotherapy- particularly if distant spread is present

  8. Diffuse lymphoma involving stomach- treated by chemotherapy. Surgery is indicated only if there is gastric perforation or gastric bleed and may need gastrectomy.

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